Basic Employment Application Form

Full Name*

First NameLast Name

Phone Number*

Area CodePhone Number

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

E-mail*

Confirmation Email

Position applying for?*

Do you have candle making experience?*

YESNO

If yes, explain:*

If no please put NA

Do you have Management experience?*

YESNO

If yes, explain:*

If no please put NA

Wage expectations*

Referral source*

Are you over the age of 18?*

YESNO

If no, what's your age?*

If 18 or over put NA

Are you eligible to work in the United States?*

YESNO

Are you currently employed?*

YESNO

Date available for work*

MonthDayYear

What position are you seeking?*

Part timeShift work (private events)

Do you have reliable transportation?*

YESNO

Have you been convicted of a felony/misdemeanor (other than traffic violations)?*

YESNO

If so, explain:*

If no please put NA

EDUCATION

Highest level of education completed:*

Please complete the appropriate sections

	Name & Location of School	Number of Years Attended	Did You Graduate?	Degree or Certification
GED / High School
College

WORK HISTORY

Please list your previous/current employer,

1. Employer

Employer's Name (Most current)*

Address & location of business*

Your title*

May we contact this employer?*

YESNO

Supervisor's name*

First and Last Name

Phone number*

Area CodePhone Number

Start date*

MonthDayYear

End date

MonthDayYear

Work performed:*

Reason for leaving*

Put NA if still employed

ADDITIONAL INFORMATION

List any additional information you would like us to consider:

REFERENCES

List three professional references, (business or work, not relatives) that you have known for at least one year. List at least one previous supervisor.

1. Full Name*

First NameLast Name

Company*

Best phone number to reach them*

Area CodePhone Number

Years acquainted*

Relationship*

AUTHORIZATION

I understand that Wixporium Candle Bar is making no employment offer at this time. I certify that the information in this application is correct to the best of my knowledge. I understand that any misrepresentation or omission of any fact in my application, resume, or any other materials, or during interviews is grounds for disqualification from further consideration for employment or for termination, if employed.

I authorize Wixporium Candle Bar to contact any company, institution, or individual it deems appropriate to investigate my employment history, character, qualifications, and other relevant information, if job-related. I give my full consent for all contacted individuals, including former employers, to provide information concerning this application, and I waive my right to bring any cause of action against these individuals for any and all liability for damages arising from furnishing the requested information to Wixporium Candle Bar. I acknowledge that a facsimile and/or photocopy of this form is as valid as the original.

Pre-employment background check may be required. I understand that any offer of employment may be withdrawn if a condition is discovered for which no reasonable accommodation can be made.

I understand that if hired, employment is at-will, regardless of the employer, and may be terminated by myself, the employer or Wixporium Candle Bar at any time, with or without cause or notice, for any reason or no reason.

By entering your name, you agree to accept the terms of the above document with an electronic signature.*

I agreeI do not agree

You must agree to accept the terms of the document in order to submit an application.

Signature*

Date*

MonthDayYear

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